本文關(guān)鍵詞：基于醫(yī)案的麻杏石甘湯證量效關(guān)系研究　出處：《北京中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

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【摘要】：證是中醫(yī)學(xué)對(duì)診斷和認(rèn)識(shí)疾病的高度概括,是中醫(yī)學(xué)特有的學(xué)術(shù)概念。方藥量效關(guān)系研究離不開證,證量效關(guān)系研究是方藥量效關(guān)系研究的核心內(nèi)容。證影響并決定著療效,方藥量效關(guān)系的研究不能脫離開"證"。本文旨在通過對(duì)經(jīng)方麻杏石甘湯方證的研究試圖闡釋其證量效關(guān)系的特點(diǎn)和規(guī)律,以期更好地指導(dǎo)臨床。首先,本文對(duì)歷代醫(yī)家使用麻杏石甘湯的病案進(jìn)行了整理,共獲得符合納入標(biāo)準(zhǔn)的醫(yī)案135個(gè)。然后對(duì)每個(gè)醫(yī)案的癥狀進(jìn)行重點(diǎn)解析,對(duì)主要癥狀之間的相關(guān)性進(jìn)行研究,并對(duì)醫(yī)家使用麻杏石甘湯原方的規(guī)律進(jìn)行總結(jié)。在此基礎(chǔ)上,運(yùn)用數(shù)理統(tǒng)計(jì)方法(層次分析法)和專家調(diào)查法,對(duì)麻杏石甘湯適用的四個(gè)主要證型:外寒內(nèi)熱證、風(fēng)熱犯肺證、肺熱熾盛證和痰熱壅肺證,其主證隸屬度進(jìn)行評(píng)判,從而得出每一病案的治療前后量化結(jié)果,進(jìn)而對(duì)各證型的證量效關(guān)系進(jìn)行分析。研究表明,麻杏石甘湯多用于治療外感引發(fā)的發(fā)熱咳喘類疾患,并以新感居多;在外感邪氣方面,寒邪居首,其次為風(fēng)熱和時(shí)邪;風(fēng)寒之邪侵襲人體后,以表邪悉入在里化熱為主要發(fā)展趨勢(shì),寒邪侵襲人體,稽留體表的時(shí)間一般在1周以內(nèi);對(duì)麻杏石甘湯證而言,發(fā)熱(86%)和喘促(76%)為麻杏石甘湯證的兩個(gè)主要癥狀;在麻杏石甘湯證中,對(duì)于發(fā)熱程度,從低熱、中等熱一直到高熱、壯熱,麻杏石甘湯證皆可見到,不必拘泥于"無大熱",且發(fā)熱程度與有無汗出以及汗出多少無明顯相關(guān)性;咳喘與痰并見的可能性為50%。在治法方面,麻杏石甘湯證以清為主,往往清宣并用,可以"清、宣、開"三字概括;麻杏石甘湯原方用藥特點(diǎn)為:麻黃用量的最大值與最小值之間相差為10倍,生石膏為5倍,甘草為4倍,杏仁為1.7倍。生石膏用量一般為麻黃的4倍,而麻黃用量略多于甘草。在麻杏石甘湯的加味藥物(≤4味)中,被使用的頻次由高到低依次為黃芩、桑白皮、貝母、葶藶子、桔梗、蘇子、蘆根和銀花。在用量方面,麻黃主要集中在3克、5～6克和9～10克三個(gè)位點(diǎn);杏仁主要集中在6克、9克和10克三個(gè)位點(diǎn);生石膏用量則以30克為拐點(diǎn);甘草用量以3克為最多,其次分別為6克和10克。在因地施量方面,對(duì)于麻黃的使用,南方醫(yī)家用藥量少于北方,表現(xiàn)為3個(gè)明顯施量平臺(tái)(9～10克、5～6克、3克)且用藥較為平緩,而北方醫(yī)家用藥較為急驟,表現(xiàn)為2個(gè)施量平臺(tái)(9～10克、6克);在生石膏、杏仁用量上,南北方?jīng)]有明顯差別;在甘草用量上,南方用量低于北方,這與麻黃的用量特點(diǎn)是一致的。在因人施量方面,麻杏石甘湯原方各藥物組成在成人與嬰幼兒之間差異顯著。在麻黃用量上,成人是嬰幼兒的2倍;在生石膏用量上,成人明顯多于嬰幼兒;在甘草用量上,成人近乎是嬰幼兒的2倍。在因癥施量方面,對(duì)于發(fā)熱這一主要癥狀,生石膏用量表現(xiàn)出這樣特點(diǎn):即以高熱(大于39℃)為拐點(diǎn),隨著熱勢(shì)增高,生石膏用量明顯加大,與非高熱比較,具有極顯著差異(P0.001)。而喘的表現(xiàn)十分復(fù)雜,對(duì)于嬰幼兒來說,隨著喘促程度的加重,麻黃用量略有增加,而杏仁用量卻有所減少,但均無統(tǒng)計(jì)學(xué)上意義。在因證施量方面,對(duì)于麻杏石甘湯原方,在生石膏和麻黃用比方面,外寒內(nèi)熱型最小(2.88:1),而風(fēng)熱犯肺型最高(5.7:1),其余兩個(gè)證型略小于風(fēng)熱犯肺證。在證量效關(guān)系方面,病情程度越重(即病案分值越高),單劑治療效果也越好,且患者一般服用一劑的效果,病情大約減輕1/3。隨著麻杏石甘湯證的加重,無論是原方用量,還是加味后的整方用量,都顯著增加。在組成麻杏石甘湯的四味藥中,麻黃和杏仁用量與證的輕重?zé)o直接相關(guān)性,而生石膏則具有顯著相關(guān)性。隨著病情加重,生石膏用量也隨之增加,并具有顯著差異。此外,在甘草用量方面,也隨著證候的加重略有所增加,且重證與輕證相比具有統(tǒng)計(jì)學(xué)上的差異。由此說明,生石膏用量對(duì)于治療麻杏石甘湯證的重要性。最后,本文對(duì)《傷寒論》麻杏甘石湯證條文補(bǔ)充如下:傷寒二三日或四五日,發(fā)熱,喘促氣急,或咯痰(53%),或渴(38.5%),或汗出(28.9%),或咳(21%),脈數(shù),舌上苔者,麻杏石甘湯主之。本研究創(chuàng)新之處在于,立足醫(yī)案對(duì)"證-量-效"關(guān)系進(jìn)行了較為系統(tǒng)的研究,即緊緊以"證"為核心,從病因、演變、癥狀、證候、藥物用量等方面進(jìn)行深入分析,力求體現(xiàn)中醫(yī)學(xué)研究的特點(diǎn)和規(guī)律,并試圖得出一些對(duì)臨床有指導(dǎo)價(jià)值的結(jié)論。
[Abstract]:Syndrome is a high summary of diagnosis and understanding of diseases in traditional Chinese medicine. It is a unique academic concept in traditional Chinese medicine. The research on the effect relationship of prescription dose is inseparable from the evidence, and the research on the relationship between quantity and effect is the core content of the research on the dose effect relationship of square medicine. The evidence affects the effect and determines the effect. The research on the dose effect relationship of the prescription can not be removed from the "syndrome". This paper aims to study the prescription of Maxingshigan Decoction prescription to the characteristics and rules of dose-response relationship explains the evidence, in order to better guide clinical. First of all, this paper used Maxingshigan Decoction on the traditional medical records were collected, were obtained in accordance with the inclusion criteria of 135 cases. Then for each case the symptoms were analyzed, to study the correlation between the main symptoms, and the physicians used Maxingshigan Decoction of summary. On this basis, the use of mathematical statistics method (AHP) and Delphi method, four main syndromes of Maxingshigan decoction is: cold and heat syndrome, syndrome of wind heat invading lung, lung heat syndrome and phlegm heat in the lung, the main card membership evaluation obtained before and after treatment each record quantitative result, then analysis permits the quantity effect relationship of each type. Research shows that mxsgd for fever diseases caused by exogenous cough treatment, and a new sense of the majority; in exopathy, Hanxie first, followed by the wind and evil; the cold evil invasion of the body, the evil in the table noted as the main development trend in the hot and cold evil invasion the surface of the human body, missed time in 1 weeks; Gan Decoction on maxingshi, fever and dyspnea (86%) (76%) two main symptoms for maxing Gan Tang card; Gan Decoction in Maxing, the degree of fever, fever, from medium heat until hot and strong heat can be seen, maxing Gan Tang card, do not have to stick to the "hot", and the degree of fever with sweating sweating and many have no obvious correlation with phlegm and cough; possibility for 50%. In the method, mxsgd card to clear the main, often clearing and use, can "clear, declared," three words; Maxingshigan Decoction for drug use: the maximum amount of Ephedra and minimum difference of 10 times, 5 times of gypsum, licorice 4 times almond, 1.7 times. The amount of raw gypsum is generally 4 times as much as ephedra, while the amount of Ephedra is slightly more than that of Glycyrrhiza. Gan Jiawei Decoction in medicine maxingshi (less than 4, taste) is used in frequency from high to low as Radix Scutellariae, Morus alba, Fritillaria, Tinglizi, Platycodon root, perilla seed, reed rhizome and honeysuckle. In terms of dosage, ephedra mainly concentrated in three loci of 3 grams, 5~6 grams and 9~10 grams. The almond mainly concentrated in 6 grams, 9 grams and 10 grams three sites. The gypsum consumption was 30 grams, the licorice consumption was 3 grams, followed by 6 grams and 6 grams respectively. In due to the application amount, for the use of ephedra, south medicine dosage is less than the north, showed 3 distinct application platform (9 to 10 grams, 5 ~ 6 grams, 3 grams) and the drug is relatively smooth, and the north were compared for 2 more quickly, the amount of the platform (9 ~ 10 grams, 6 grams); in gypsum, almond dosage, there was no significant difference between North and South in the South; licorice dosage, dosage is less than the north, which is consistent with the characteristics of dosage of ephedra. The amount of people in terms of Maxingshigan decoction, the drug composition of significant differences between adult and infant. In the dosage of ephedra, the adult is 2 times as high as that of the infant; in the amount of raw gypsum, the adult is obviously more than the infant; in the dosage of Glycyrrhiza, the adult is almost 2 times more than that of the infant. In terms of the amount of disease, for the main symptom of fever, the dosage of gypsum is characterized by high heat (greater than 39 degrees) as the turning point. With the increase of heat potential, the dosage of gypsum is significantly increased, which is very different from that of non high fever (P0.001). And the manifestation of asthma is very complicated. For infants and young children, the amount of Ephedra increased slightly, and the amount of almond decreased, but there was no statistical significance. Because the amount of cards in hand, for Maxingshigan Decoction in gypsum and ephedra use ratio, cold heat type (2.88:1), minimum and maximum wind heat Fanfei type (5.7:1), the remaining two card type is slightly less than the syndrome of wind heat invading lung. In terms of dose effect relationship, the more serious the disease is, the higher the score of medical record is. The better the effect of single agent is, the more patients will take 1/3. With the aggravation of Maxingshigan decoction, regardless of the original amount, or modified after the whole prescription dosage, were significantly increased. In the composition of Maxingshigan Decoction of four drugs, no direct correlation between ephedra and almond dosage and syndrome severity, and is significantly associated with gypsum. With the aggravation of the disease, the amount of gypsum is also increased, and there is a significant difference. In addition, in the dosage of Glycyrrhiza, the aggravation of the syndrome is slightly increased, and there is a statistical difference between the heavy evidence and the light syndrome. This shows that gypsum dosage for the treatment of the importance of Maxingshigan Decoction syndrome. Finally, this article on the "Treatise on the" Maxinganshi Decoction provisions added as follows: two or three days or four or five days of fever, fever, dyspnea or shortness of breath, sputum (53%), or thirsty, or (38.5%) (28.9%), sweating or cough (21%), the number of vein, tongue moss, maxinshigan Decoction of. The innovations of this study is based on medical records, "syndrome - the dose-response relationship was studied systematically, which is tightly to the" card "as the core, evolution, from the etiology, symptoms, syndromes, drug dosage and other aspects of in-depth analysis, to study the characteristics and laws of TCM, and tries to get some guiding value for clinical results.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R289.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉佳緣;王宇;陳艷焦;楊永清;;“辨證論治”詞語源流考[J];上海中醫(yī)藥雜志;2016年06期

2 王倩;趙思佳;馮青;傅延齡;;麻杏石甘湯當(dāng)代醫(yī)案分析述評(píng)[J];遼寧中醫(yī)雜志;2015年06期

3 姜麗;李佳;李冰濤;李惠蘭;饒毅;王躍生;徐國(guó)良;;石膏對(duì)麻杏石甘湯中5個(gè)主要成分含量的影響[J];中國(guó)實(shí)驗(yàn)方劑學(xué)雜志;2014年17期

4 崔艷茹;屈飛;徐鏡;徐國(guó)良;;石膏劑量變化對(duì)麻杏石甘湯解熱效應(yīng)的量效關(guān)系研究[J];中國(guó)實(shí)驗(yàn)方劑學(xué)雜志;2013年23期

5 何軍強(qiáng);厚紀(jì)東;;淺談麻杏石甘湯化裁的臨床用藥體會(huì)[J];國(guó)醫(yī)論壇;2013年06期

6 管胥伯;;麻杏石甘湯兒科應(yīng)用[J];實(shí)用中醫(yī)內(nèi)科雜志;2013年04期

7 趙思佳;馬艷紅;傅延齡;張林;;麻杏石甘湯治療小兒肺炎隨機(jī)對(duì)照試驗(yàn)的系統(tǒng)評(píng)價(jià)及量效分析研究[J];中華中醫(yī)藥雜志;2013年02期

8 屈飛;崔艷茹;徐鏡;徐國(guó)良;黃麗萍;余日躍;;麻杏石甘湯解熱作用量效關(guān)系研究[J];中國(guó)實(shí)驗(yàn)方劑學(xué)雜志;2013年03期

9 岳建華;;經(jīng)方臨證治驗(yàn)4則[J];山西中醫(yī);2012年11期

10 趙厚睿;戴紅;;方證辨證與辨證論治的探源[J];江西中醫(yī)藥;2011年12期

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